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Concomitant antidepressant, NSAID use may raise risk for intracranial hemorrhage
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The combined use of antidepressants and NSAIDs resulted in a greater risk for intracranial hemorrhage than antidepressants alone, according to the results of a propensity score-matched study.
“Depression produces the greatest decrement in health of all common chronic conditions, and depression in older people is an important public health problem,” Byung-Joo Park, MD, PhD, professor of preventive medicine at Seoul National University College of Medicine in Korea, and colleagues wrote. “Antidepressants can help depressive patients effectively, but concern exists that antidepressants may interact unfavorably with NSAIDs.”
Park and colleagues conducted a retrospective national propensity score-matched cohort study by evaluating nationwide health insurance database records from 2009 to 2013.
The analysis included patients who began receiving antidepressants for the first time who did not have a history of receiving antidepressants in the previous year. The researchers excluded patients diagnosed with cerebrovascular diseases within a year of their index date.
The time to first hospitalization with intracranial hemorrhage within 30 days of drug use served as the primary endpoint. The researchers categorized patients based on receipt of antidepressants with or without NSAIDs.
The final analysis included data from 4.1 million patients who used antidepressants alone (n = 2,764,779) or with NSAIDs (n = 2,404,054).
Patients who took antidepressants and NSAIDs faced a greater risk for intracranial hemorrhage within 30 days of index date compared with patients who used antidepressants alone (HR = 1.6; 95% CI, 1.32-1.85).
The risk for intracranial hemorrhage associated with antidepressant and NSAID use appeared greater in males (HR = 2.6; 95% CI, 1.93-3.42) than females (HR = 1.2; 95% CI, 0.89-1.57).
However, the risk for intracranial hemorrhage did not significantly vary according to patient age, subtype of hemorrhage, or class of antidepressant drug.
The researchers acknowledged potential coding inaccuracies and incompleteness of available records as limitations to these findings. They also noted the possibility for selection bias, as the analysis was limited to patients admitted to a hospital for intracranial hemorrhage.
“The addition of NSAIDs to antidepressant treatment increased the risk [for] intracranial hemorrhage within 30 days of the combination starting, especially in men,” Park and colleagues concluded. “This result adds to evidence confirming the increase of risk with combination use of antidepressants and NSAIDs. Special attention is needed when patients use both of these drugs together.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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